the relationship between mental health indicators and adjudication rates among youth with serious...
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The Relationship between Mental Health Indicators and Adjudication Rates Among Youth
with Serious Emotional Disturbance Michele Ybarra, M.P.H.1
Christine Walrath, Ph.D.2
Wayne Holden, Ph.D. 2
Rolando Santiago, Ph.D. 3
Phil Leaf, Ph.D. 1
1Johns Hopkins Bloomberg School of Public Health2ORC MACRO
3Child, Adolescent and Family Branch - Center for Mental Health Services
International Association of Forensic Mental Health Services Annual Conference, April 2003, Miami FL
* Thank you for your interest in this presentation. Please note that analyses included herein are preliminary. More recent, finalized analyses may be available by contacting CiPHR for further information.
Juvenile Justice Involvement and Mental Health
An estimated 2.5 million juvenile arrests were reported in 1999 (Shelton, 2001).
Youth involved with the juvenile justice system have high rates of mental disorder (Shelton, 2001; McManus, Alessi, Grapentine & Brickman, 1984; Wierson, Forehand & Frame, 1992; Teplin, Abram,
McClelland, Dulcan, & Mericle, 2002).
Youth with Prior Justice Involvement Currently Receiving Services
20% of youth in the public mental health system have a history of juvenile arrest
(Rosenblatt, Rosenblatt & Biggs, 2000; Vander Stoep, Evens, & Taub, 1997; Breda, 1995).
Compared to youth receiving mental health services without prior justice involvement, dually-involved youth are: (Rosenblatt, Rosenblatt & Biggs, 2000; Bryant et al., 1994)
more likely to be diagnosed with substance abuse and behavior disorders (e.g., conduct disorder).
less likely to be diagnosed with an anxiety disorder.
Study Rationale Similar studies to date have focused on regional
samples. The unique characteristics of justice-involved
youth provide critical information to the individualized service planning process, therefore we must investigate mental health challenges faced by
dually involved youth and how they differ from other service-referred youth.
This study compares the rate of prior adjudication of service-referred youth as a function of the presence versus absence of specific mental health challenge
indicators.
Study Methodology
Data were collected by communities funded in 1993 and 1994 (22 sites) as part of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program.
Sample Selection Criteria:1) Youth participating in the child and family outcome study of
the national evaluation (of a possible 18,906).
2) 10 years of age or older
3) Complete data on 7 study variables.
2,662 who had complete data Study SampleStudy sample contained slightly more Caucasian youth and youth of ‘other’ races.
Measures and Indicators
Demographic characteristics
Age
Gender
Race/ethnicity
Household income
Mental health indicators
Global Assessment of Functioning
Primary Axis I diagnosis
Presenting problem(s)
History of delinquency
Prior adjudicated misdemeanor
Prior adjudicated felony
History of Adjudication by Gender(N=2,662)
Females with no prior adjuication
31%
Females with > = 1 prior adjudication
6%Males with no prior adjudication
49%
Males with > = 1 prior adjudication
14%
History of Adjudication by Race/Ethnicity
65%
8%12%
15%
58%
10%
21%
11%
0%
10%
20%
30%
40%
50%
60%
70%
White Black Hispanic Other
Race/Ethnicity
Per
cen
tag
e o
f Y
ou
th i
n S
amp
le
No prior adjudciation
> =1 prior adjudication
N=2,662
History of Adjudication by Age
13% 14% 14%15%
14% 14%
10%
5%
2%4% 5%
12%
18%19%
24%
15%
0%
5%
10%
15%
20%
25%
30%
10 11 12 13 14 15 16 17
Age (years)
Per
cen
tag
e o
f Y
ou
th i
n S
amp
leNo prior adjudciation
>=1 prior adjudication
N=2,662
Prevalence of Psychiatric Disorder by Adjudication History
32%
23% 20%
9%
1%
52%
21%
11%4% 4%
0%
10%
20%
30%
40%
50%
60%
Conduct D
isord
er
Majo
r Depre
ssio
n/Dys
thym
ia
ADHD
Anxiety
Substan
ce R
elat
ed D
isord
er
Primary Axis I Disorder
Per
cen
tag
e o
f Y
ou
th i
n S
amp
le
No Adjudications
>=1 adjudication
adjusted for race/ethnicity, household income, and gender
(N=2,662)
Analytic Approach
Poisson for count data used to calculate the relative rates of adjudication as a function of multiple indicators of mental health (adjusted for gender, race/ethnicity, household income): Global Assessment of Functioning (lowest 16%
of sample versus higher) Primary Axis I Diagnosis Reason for Referral to Services
Analytic Approach (cont.)
Comparisons of youth by adjudication history and primary diagnosis χ2 tests for differences across the four groups
Prior adjudication w/ CD / Substance-Related Disorder (SRD)
Prior adjudication w/o CD / SRD
No prior adjudication w/ CD / SRD
No prior adjudication w/o CD / SRD
Comparison of demographic characteristics
Relative Rates of Prior Adjudication as a Function of Primary Psychiatric Diagnosis
2.08
1.7
1.23
3.09
0.85
1.25
0.62 0.650.45
0.210
0.5
1
1.5
2
2.5
3
3.5
Adjudication Type
Rel
ativ
e R
ate
of
Ad
jud
icat
ion
s
Conduct Disorder
Substance Related Disorder
Depression/Dysthymia
ADHD
Anxiety
(N=2,662) adjusted for race/ethnicity, household income, and gender
Misdemeanor(s) Felony(s)
***
***
*
**
***
****
***
***
***p<.001; **p<.01; * p<.05
Relative Rates of Prior Adjudication as a Function of Global Functioning
1.16
1.34
1
1.1
1.2
1.3
1.4
Misdemeanor(s) Felony(s)
Adjudication Type
Re
lati
ve
Ra
te o
f A
dju
dic
ati
on
s
(N=2,662)
adjusted for race/ethnicity, household income, and gender
**
*
**p<.01; * p<.05
Relative Rates of Prior Adjudication as a Function of Reason for Referral into Services
3.00
1.76
1.22
0.760.75 0.780.67 0.73
0.61
0.88
0.51
0.93
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
Adjudication Type
Re
lati
ve
Ra
te o
f A
dju
dic
ati
on
s
Delinqueuncy-Related
Conduct-Related
Suicide
Hyperactivity
Adjustement-Related
Depressed Mood
(N=2,662)adjusted for race/ethnicity, household income, and gender
**
***
**
***
***
****** ***
**
Misdemeanor(s) Felony(s)
***p<.001; **p<.01; * p<.05
Putting it all Together: Relative Rates of Adjudication
Mental Health Indicator Misdemeanor(s) Felony(s)
Primary Psychiatric Diagnosis
Conduct Disorder > >
Substance Related Disorder >
Depression/dysthymia < >
ADHD < <
Anxiety < <
Reason for Referral
Delinquency-Related > >
Conduct-Related > <
Suicide <
Hyperactivity < <
Adjustment-Related <
Depressed Mood <
Global Assessment of Functioning > >
Comparisons of Youth by Adjudication History and Primary Diagnosis
9%
53%
11%
27%
0%
10%
20%
30%
40%
50%
60%
> = 1 None
Ajudication History
Pe
rce
nta
ge
of
Yo
uth
in S
am
ple
Conduct or Substance-Related Disorder
No Conduct or Substance-Related Disorder
(N=2,662)
Age as a Function of Four Groups of Adjudication-Primary Diagnosis
14.714.8
13.0
13.3
12.0
12.5
13.0
13.5
14.0
14.5
15.0
Adjudciation-Primary Diagnosis Category
Me
an
Ag
e (
ye
ars
)***
Prior Adjudication w/o CD/SRD
Prior Adjudication w CD/SRD
No Prior Adjudication w/o CD/SRD
No Prior Adjudication w CD/SRD
(N=2,662)
*** F=34.8; p<.001
Gender as a Function of Four Groups of Adjudication-Primary Diagnosis
68%
70%
60%
63%
54%
56%
58%
60%
62%
64%
66%
68%
70%
72%
% Male***
Pe
rce
nt
of
Yo
uth
wit
hin
Ad
jud
ica
tio
n-P
rim
ary
D
iag
no
sis
Ca
teg
ory
Prior Adjudication w/o CD/SRD
Prior Adjudication w CD/SRD
No Prior Adjudication w/o CD/SRD
No Prior Adjudication w CD/SRD
(N=2,662)
***χ2=16.1; p<.001
Race/Ethnicity as a Function of Four Groups of Adjudication-Primary
Diagnosis73%
13%
6% 8%
47%
26%
13% 14%
69%
11%7%
12%
58%
13%9%
21%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Non-HispanicWhite
Hispanic Non-HispanicBlack
Other
Race/Ethnicity***
Pe
rce
nta
ge
of
Yo
uth
wih
tin
Ad
jud
ica
tio
n-P
rim
ary
D
iag
no
sis
Ca
teg
ory
Prior Adjudication w/o CD/SRD
Prior Adjudication w CD/SRD
No Prior Adjudication w/o CD/SRD
No Prior Adjudication w CD/SRD
(N=2,662)
***χ2=110.8; p<.001
SummaryRelative rates of adjudication history differ significantly as
a function of: Primary diagnosis
conduct disorder associated with elevated rates of prior adjudication for misdemeanor and felony adjudication
substance abuse and depression/dysthymia associated with elevated rates of felony adjudication
anxiety and ADHD associated with lower rates of prior misdemeanor and felony adjudication
Reason for referral elevated rates of misdemeanors adjudication associated with
referral for delinquency and conduct-related problems lower rates of misdemeanor adjudication associated with suicide,
hyperactivity, adjustment-related, and depressed mood Global assessment of functioning
elevated rates of misdemeanor and felony adjudications associated with poor (lowest 16% of sample) functioning
Summary
44% of youth with a history of conviction had an Axis I diagnosis other than substance abuse or conduct disorder
Youth differ in terms of race/ethnicity, gender, and age as a function of adjudication history-diagnosis category.
Study Limitations
1. Cross sectional data
2. Validity of the conviction variable• Caregiver report and administrative record
3. Specific crime types not investigated
4. Collection of psychiatric diagnosis via chart review
Implications
Diagnosis at time of intake into service is significantly related to adjudication history among youth with serious emotional disturbance who are referred into system-of-care services.
Youth with a primary diagnosis other than CD-SRD and with a history of adjudication may vary in demographic characteristics compared to other youth.